Medical Care and the Alzheimer’s Patient

Our Uncle Yitzchok’s dementia made it much harder for doctors to help him with whatever else was ailing him.

“Cough,” said the doctor, while listening to his chest with his stethoscope.

“Cough,” said Uncle Yitzchok, not understanding what the doctor wanted.

Sometimes Uncle Yitzchok would grind his teeth during a stethoscope exam. How could the doctor possibly hear his heartbeat with that loud grinding going on?

Yes, dementia makes it very hard for the doctor to take care of a patient. The doctor is still responsible for conducting a proper examination and for making good medical plans for the patient, but the critically important communication with the patient is entirely lacking.

Alzheimer’s disease, like other serious illnesses, can create overwhelming practical and financial problems for the family. The patient becomes unable to live alone, less and less mobile, unable to feed himself, frail and wheelchair-bound, and increasingly vulnerable to infections.

In addition to all these practical and financial problems, Alzheimer’s disease presents the family and friends with unique emotional and spiritual challenges. Some families feel that their family member, although extremely limited in his abilities, is still “there” and still with them, whereas in other cases, painfully, the patient seems like a stranger and perceives them in the same way. Ultimately, the patient may be so limited in his ability to communicate that the family can only imagine what is going on in his mind, if anything.

How does the family interpret this painful experience? How do they reconcile it with their previous conceptions of the mind and the soul and their ideas about the obligations of family members one to another?

Harmful ideas circulating in our society

Our society as a whole has been severely strained and stressed by this disorder. Unprepared for this large population of helpless people, America has not exactly embraced the challenge of taking care of them. Instead of devoting more resources to providing for them, instead of finding new ways to help their families, our culture has tried to shirk this burden by creating all kinds of justifications for allowing these people to die earlier even before they become completely debilitated.

First, they make the medically false claim that patients with Alzheimer’s disease are in the category of the imminently dying. This is not the case. Patients with Alzheimer’s disease can live for a very long time if they receive treatments for secondary problems like pneumonia and urinary tract infections and if they are carefully handfed or given feeding tubes if necessary.

Another unfounded idea that is circulating in our society is that somehow the Alzheimer’s patient, because of his cognitive deficits, is no longer a full human being and isn’t entitled to treatment. Of course, this is not the Jewish view.

What are the rulings of our Gedolim?

Two recent statements from our Gedolim are very clear in directly addressing this issue and leave no room for confusion.

The first psak halacha is dated Elul, 5774 and it is entitled “Daas Torah B’Inyan HaTipul B’Choleh Chaser Da’as.” It is signed by Rav Chaim Kanievsky, Rav Yitzchak Zilberstein, Rav S. Y. Nissim Karelitz and Rav Tuvya Weiss of the Aida Hacharedis, and also by a list of other Rabbis. It states that according to the Torah, it is obligatory to treat the patient who is lacking da’as in the same way as we are obligated to treat patients whose intelligence is unimpaired, and that it makes no difference if the patient is young or old, and that it is a mitzvah to be mechallel Shabbos to save him even if it is just to add a only a short time to his life.

The second even more recent statement, released in Sivan, 5775, and signed also by Rav Chaim Kanievsky, Rav Yitzchak Zilberstein, Rav S. Y. Nissim Karelitz and Rav Tuvya Weiss of the Aida Hacharedis, contains a comprehensive list of different kinds of seriously ill patients, stating that they must receive full treatment in spite of their lowered quality of life. An entire paragraph of this psak halacha is devoted to the Alzheimer’s patient, saying that he should be fully treated and admitted to the ICU like any other healthy person. It specifies that this includes even Alzheimer’s patients at a very severe level who are completely unaware of their environment .

How can we carry out the rulings of our Gedolim in today’s society?

We live in a time when the attitudes in our society are veering away farther and farther from the Torah. Goals are being set to persuade more and more families not to pursue medical care for patients considered to be terminally ill. Some medical practitioners are even showing patients videos in the hope of persuading them to sign documents relinquishing medical care. We have to be so careful about the ideas that we absorb from those around us. Jewish families struggling with Alzheimer’s disease have mistakenly thought that they were not obligated to give their loved ones full medical treatment, and they have unknowingly allowed them to perish before their time. They have not called for emergency help when the patient collapsed, thinking that it wasn’t necessary.

Chayim Aruchim - Center for Culturally Sensitive Heath Advocacy & Counseling. Chayim Aruchim is addressing these problems that threaten the lives of our loved ones with Alzheimer’s disease. When a hospital physician, schooled in the most current ideology circulating in our culture, tells a Jewish family that the hospital can’t or won’t give further treatment to the patient, Chayim Aruchim can send in Rabbis who have been extensively trained to question the doctors and determine the actual details of the patient’s condition. Armed with these details, a posek experienced in medical questions can be consulted, and then liaisons associated with Chayim Aruchim can help to insure that this psach is actually carried out. They are able to do this because they have had extensive meetings with hospital CEOs in the New York area and have emphasized to them that the law is on our side - the family is supposed to have the right to assert the patient’s wish for continued aggressive medical treatment.

Chayim Aruchim maintains a 24 hour hotline (718 301 9800) for families and Rabbonim seeking information on medical and halachic issues, and for families whose loved one is about to be discharged from a hospital, they have a discharge consultant available (718 535 9061).

Chayim Aruchim has grown tremendously in the last few years and will hopefully continue in the future to expand their services to other areas of the country! Hopefully Jewish communities will become more aware of the problems of those struggling to care for their relatives and will find ways of providing community support.